1. Multiple Social-Environmental Risks and Mother-Infant Interaction among Mother-Premature Infant Dyads Kristin Rankin, PhD Camille Fabiyi, MPH Kathleen Norr, PhD Rosemary White-Traut, PhD, RN, FAAN University of Illinois at Chicago

2. Presenter Disclosures (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Kristin Rankin No relationships to disclose

3. Background  Premature infants with biologic risk plus social-environmental risks have poorer health and development than: –Premature infants in less stressed families –Full term infants in families with multiple social-environmental risks  Prematurity and social-environmental risks both lead to lower quality of mother-infant interaction  Poor mother-infant interaction is associated with poorer infant health and development

4. Purpose  To examine the association between social-environmental (SE) risks and the quality of mother-premature infant interaction  The relative importance of the following will be compared: –Individual risk factors –Cumulative # of factors –Specific patterns of risk factors

5. Design and Procedure  Randomized clinical trial at two community-based hospitals  Recruitment and enrollment of mothers shortly after the birth of a premature infant  Inclusion criteria: Otherwise healthy infants, 29-34 weeks gestational age; Mothers with at least 2 of 10 baseline social-environmental risk factors, e.g. poverty, minority status, mental health issues  Maternal intake interview to assess socio-demographic characteristics, baseline mental health and social support  Follow-up interviews in hospital before infant’s discharge and at six weeks corrected age

6. Dependent Variable: Mother Infant Interaction  Mother-infant interaction during feeding: NCAST (Nursing Child Assessment Satellite Training – Feeding Scale) –Scored for maternal and infant behaviors on 76-item scale –Maternal sensitivity to cues, response to child’s distress, social-emotional and cognitive growth fostering –Infant clarity of cues and responsiveness to mother  Assessed from a videotaped feeding session in the hospital, just before infant’s discharge

7. Independent Variables: Social Environmental Risk Factors SE RiskDefinitionSample Prevalence % Minority statusAfrican-American or Latina100 Teen birthAge at delivery < 2019 Low educationTeens: <HS and not in school 20 and older: <High School 23 PovertyHousehold income < 185% FPL and/or WIC participation 89

8. Independent Variables: Social Environmental Risk Factors SE RiskDefinitionSample Prevalence % Childcare burden Previous child <24 months or ≥ 4 children in household 35 Not living with baby’s father Self-report44 Resides in disadvantaged neighborhood Index of Neighborhood Disadvantage Score > 0 38

9. Independent Variables: Social Environmental Risk Factors SE RiskDefinitionSample Prevalence % Depression Self-reported history, CES-D score ≥ 16, or PDSS score ≥ 60 42 High trait anxiety STAI Y-2 (highest quartile, ≥ 35 25 Low social support <88 (lowest quartile) Personal Resources Questionnaire (PRQ) 2000 24

10. Other Sample Characteristics Characteristics n = 188 Maternal Age at delivery (m, sd)26 (6.6) Race/ethnicity: African-American Latina 50 Parity (% Primiparous)39 Infant Sex (% Male)50 GA at birth in weeks (m, sd)32.5 (1.5) Birthweight in grams (m, sd)1822 (375)

11. Data Analysis – 3 Methods  T-tests to identify the impact of individual SE risk factors on mean NCAST scores  Linear regressions for the cumulative number of risk factors as predictors of NCAST scores  Hierarchical cluster analysis to identify patterns of risk factors, followed by linear regression to assess relationship between patterns and NCAST scores – Linkage Method= Ward’s Minimum Variance – Assessed Criteria for Number of Clusters (CCC, Pseudo F, Pseudo T 2 – Stratification by age group prior to clustering (≥ 20, <20)

12. Mean NCAST scores by Individual SE risks Individual Risk FactorsnNCAST score Mean (SD) Overall Mean10860 (6.7) Baby’s father not living in HH*4861.9 (5.5) Baby’s father living in HH6058.7 (7.1) High Trait Anxiety*2556.9 (8.4) Low Trait Anxiety8361.1 (5.7) *p < 0.05

13. Mean NCAST scores by Cumulative Number of SE Risks

14. Mean NCAST Scores by Patterns of SE Risks ClusterCluster LabelnNCAST Mean (SD) Adult-1Impoverished only2760.8 (5.8) Adult-2Depressed only2261.0 (6.3) Adult-3Impoverished, disadvantaged neighborhood, high child care burden, father absence 2160.7 (5.5) Adult-4Impoverished, less than high school education 854.0 (9.4)* Adult-5Low education, depressed, anxious, low support, disadvantaged neighborhood 1360.5 (6.6) Teen-1Low risk teens860.5 (5.6) Teen-2Depressed, anxious, low support, higher childcare burden teens 958.9 (9.1) *p < 0.01 compared to Adult-1

15. Strengths/Limitations Strengths  Wide variety of SE risk factors measured at baseline  Underserved and understudied population of women and infants Limitations  Small sample size  Dichotomous risk factors  Generalizability

16. Conclusions  Women with high trait anxiety and those with baby’s father in the household appear to have lower quality interactions  The cumulative number of risk factors is not correlated with mother-infant interaction in a dose-response fashion

17. Conclusions  Women were identified as belonging to clusters according to patterns of SE risks  Patterns of SE risks may be more relevant than the total number of risk factors with regard to outcomes  A subgroup of impoverished women with less than a high school education had the lowest quality interaction of all groups in the sample

18. Implications  Education and economic opportunity are crucial  Women with SE risks who just had a preterm infant should receive anticipatory guidance to help improve mother-infant interaction  Women with both low education levels and economic disadvantage may especially be in need of guidance  Future directions include examining other study outcomes by clusters

19. Acknowledgements  Funded by the National Institute of Child Health and Development, the National Institute of Nursing Research (1 R01 HD050738-01A2) and the Harris Foundation  The authors wish to acknowledge the infants and their parents who participated in this research